The Epidemiology of Alcohol and Drug Disorders

Abstract

Epidemiologic investigations focus on the description of the incidence and prevalence of health outcomes, and the identification of risk factors for health outcomes. In this chapter, we review the historical and current evidence on the epidemiology of alcohol and drug consumption and clinical diagnoses of abuse and dependence. Moderate alcohol consumption is prevalent, socially normative in Western culture, and associated with protection against health disease. Illicit drug use is less prevalent than alcohol use, but current estimates indicate that more than half of high school seniors have used marijuana. Two diagnostic nomenclatures, the Diagnostic and Statistical Manual of Mental Disorders and the International Statistical Classification of Diseases and Related Health Problems, derive diagnoses of alcohol and drug disorders. The abuse/harmful use diagnosis captures the consequences of heavy use (social, legal, medical problems, and hazardous use), while dependence captures the physical, psychological, and behavioral manifestations of impaired control over substance use. These diagnoses are often correlated, and psychometric analyses suggest that they may derive from an underlying dimensional continuum of alcohol- and drug-related problems, rather than two separate axes of problem use. Current estimates indicate that the prevalence of alcohol abuse in the United States is 4.7 and 3.8%, respectively, and the prevalence of drug abuse and dependence is 1.4 and 0.6%, respectively. Alcohol and drug disorders are most common among individuals aged 18–29, and a high proportion of individuals recover from illness despite low rates of treatment utilization. Alcohol and drug disorders are more common among men compared with women, and among Whites compared with non-Hispanic Blacks, Asians, and Hispanics. Substance use disorders have a complex etiology involving genetic and environmental factors. We review the evidence for risk factors from the macro-level (e.g., availability, prices, laws, advertising) to the meso-level (e.g., parental and peer influences) and the micro-level (e.g., stress, cognition, personality, subjective reactions, and genetic vulnerability).

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